Palpitations Of Heart

What can we do About Them?

PROF UPENDRA KAUL

Palpitation of heart is a common symptom reported by many persons at all ages and both sexes. It is a common cause of seeking medical attention and can range in terms of seriousness from absolutely benign to potentially a life threatening problem.
A palpitation is an abnormality of heartbeat that ranges from often unnoticed skipped beats or accelerated heart rate to very noticeable changes accompanied by dizziness or difficulty breathing.

Heart palpitation symptoms can feel like:
• Skipped heartbeats
• Fluttering heartbeats
• Heartbeats that are too fast
• Heartbeats that are pumping harder than usual
Heart palpitations can be felt as a symptom in your throat or neck, as well as your chest. Heart palpitations can occur whether you're active or at rest, and whether you're standing, seated or lying down.

Palpitations can be attributed to one of the 3 major causes:
1. Anxiety is one of the important causes in young highly strung personalities and is affected by the state of mind. Psychological problems can thus induce one to palpitate. It is therefore important to consider the psycho-social aspect before coming to a conclusion. This is often due to sympathetic over drive which can be associated with panic disorders, lowering of blood sugar levels especially in diabetics, certain drugs like common cold medicines, anemia and low oxygen in the atmosphere or lung disease.
2. Hyperdynamic circulation  : common causes , Leaking heart valves , disorders of thyroid gland, fever, anemia and pregnancy.
3. Disorders of Heart rhythm :  premature atrial or ventricular beats, atrial fibrillation, supra ventricular tachycardia , ventricular tachycardia ,ventricular fibrillation etc. Some of these disorders like a ventricular tachycardia and ventricular fibrillation can be life threatening if not recognized in time.

Symptoms to be noted:
Many times, the person experiencing palpitations may not be aware of anything apart from the abnormal heart rhythm itself. But palpitations can be associated with other things such as tightness in the chest, shortness of breath, dizziness or light-headedness. Depending on the type of rhythm problem, these symptoms may be just momentary or more prolonged. Actual blackouts or near blackouts, associated with palpitations, should be taken seriously because they often indicate the presence of important underlying heart disease. Another symptom is pain in arms or legs sometimes lasting through the night after the palpitation.

Diagnostic Aids:
The most important initial clue to the diagnosis is one's description of the palpitations. The approximate age of the person when first noticed and the circumstances under which they occur are important, as is information about caffeine intake (tea or coffee drinking). It is also very helpful to know how they start and stop (abruptly or not), whether or not they are regular, and approximately how fast the pulse rate is during an attack. If the person has discovered a way of stopping the palpitations, that is also helpful information.
The diagnosis is usually not made by a routine medical examination and electrical tracing of the heart's activity (ECG), because most people cannot arrange to have their symptoms be present while visiting the doctor. Nevertheless, findings such as a heart murmur or an abnormality of the ECG, which could point to the probable diagnosis, may be discovered. In particular, ECG changes that can be associated with specific disturbances of the heart rhythm may be picked up; so routine physical examination and ECG remain important in the assessment of palpitations.
Blood tests, particularly tests of thyroid gland function are also important baseline investigations (an overactive thyroid gland is a potential cause for palpitations; the treatment in that case is to treat the thyroid gland over-activity).
The next level of diagnostic testing is usually 24 hour (or longer) ECG monitoring, using a form of tape recorder called a Holter monitor, which can record the ECG continuously during a 24-hour period. If symptoms occur during monitoring it is a simple matter to examine the ECG recording and see what the cardiac rhythm was at the time. For this type of monitoring to be helpful, the symptoms must be occurring at least once a day. If they are less frequent, the chances of detecting anything with continuous 24, or even 48-hour monitoring, are substantially lowered.
Other forms of monitoring are available, and these can be useful when symptoms are infrequent. A continuous-loop event recorder monitors the ECG continuously, but only saves the data when the wearer activates it. Once activated, it will save the ECG data for a period of time before the activation and for a period of time afterwards - the cardiologist who is investigating the palpitations can program the length of these periods. A new type of continuous-loop recorder has been developed recently that may be helpful in people with very infrequent, but disabling symptoms. This recorder is implanted under the skin on the front of the chest, like a pacemaker. It can be programmed and the data examined using an external device that communicates with it by means of a radio signal.
Investigation of heart structure can also be important. The heart in most people with palpitations is completely normal in its physical structure, but occasionally abnormalities such as valve problems may be present. Usually, the physician or cardiologist will be able to detect a murmur in such cases, and an ultrasound scan of the heart (echocardiogram) will often be performed to document the heart's structure. This is a painless test performed using sound waves and is virtually identical to the scanning done in pregnancy to look at the fetus.

Things to Remember
Patients with underlying heart disease especially with old or recent heart attacks and long standing disease of heart valves, patients with poorly functioning heart muscle should take a serious note of palpitations, dizzy spells and short lasting episodes of unconsciousness. These are the subjects who need detailed evaluation because these palpitations may be warning symptoms of something more sinister. There are many gratifying treatment modalities available these days to prevent serious events. These include pacemakers, implantable defibrillators which recognize serious arrhythmias and treat them before a nearly fatal event.
Patients with normal hearts with no underlying problems palpitations can usually be ignored but if these interfere with day to day life need to be brought to the attention of your treating physician. Very often it just needs a reassurance or some simple medicines like tranquillizers

Atrial fibrillation
This is a relatively common arrhythmia with advancing age and needs to be recognized early. It presents as a rapid and very irregular heart beat. ECG is diagnostic. It sometimes is episodic and needs long term ECG monitoring in that case. The importance of this arrhythmia is that it can lead to brain strokes which can be prevented by administering long term blood thinners. Aspirin alone is not enough to prevent these serious complications.

Tips for Prevention of palpitations and underlying heart disease
Healthy life style from a young age can go a long way to keep your heart healthy and prevent palpitations and many serious complications. These are, Regular exercise, eating a heart healthy diet, keeping blood pressure, blood sugar and blood cholesterol levels under strict control. Diabetics should watch their blood sugars regularly and keep them under control.

Author is Executive Director and Dean Fortis Escorts heart Institute and Fortis Hospital Vasant Kunj, New Delhi

Lastupdate on : Tue, 18 Dec 2012 21:30:00 Makkah time
Lastupdate on : Tue, 18 Dec 2012 18:30:00 GMT
Lastupdate on : Wed, 19 Dec 2012 00:00:00 IST




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